摘要： Cutaneous metastases are relatively uncommon, occurring in only 0.7% to 9% of all internal malignancies. Cholangiocarcinoma is a rare bile duct neoplasm that accounts for less than 2% of malignancies. Although it is well known that cholangiocarcinoma metastasizes to the lungs, liver, peritoneum, and retroperitoneal lymph nodes, a retrospective review of the literature from 1978 to 2014 indicates only 30 cases of cutaneous cholangiocarcinoma, with 17 cases presenting without concurrent metastasis in other sites. Among these patients, the cutaneous metastatic disease occurred evenly at adjacent and distant sites, presenting as 0.3-cm to 4-cm erythematous papules or nodules with or without ulceration. The median overall survival after diagnosis of cutaneous cholangiocarcinoma metastasis is 4 months. Paradoxically, single-site metastases carry a significantly worse prognosis than multiple-site metastases and may be attributed to difficulty in identifying a singular lesion. In vivo reflectance confocal microscopy (RCM) is a novel, noninvasive diagnostic alternative to skin biopsy with comparable insurance reimbursement that captures real-time, high-resolution, cellular-level images from the skin surface down to the reticular dermis (up to 300 μm depth). This modality forgoes traumatic biopsy and has been used for diagnosis and monitoring of skin cancers and inflammatory dermatoses.